Discussion about growth and developmental patterns

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Chapter 17

Infant

Human development begins when a sperm penetrates a mature ovum
Infant depends completely on others, primarily the parents, to meet all needs
Developmental landmarks
To guide parents, nurse must know what behaviors to expect at certain age levels
Physical growth landmarks
Developmental tasks

Biology and Genetics

Developmental Tasks

Physiological equilibrium
Task of survival: basic physiological functions
Oral stage of development
Stimulation and environmental interaction
Essential for infant development
Progressive connections of dendrites
Increases vascularization of brain structures
Increases myelination of brain/nerves
Infant should have auditory/visual stimuli
Radios, spoken voice, mobiles
Sense of touch important as well

Concepts of Infant Development

Psychosocial development: Erikson
Trust vs mistrust
Trust influences future relationships
Infant needs maximum gratification/minimum frustration
Cognitive development: Piaget
Sensorimotor period

Mastering simple coordination activities through senses and motor activity

Reflexes

Responses following stimulation

Rooting and sucking reflex: assists survival

Measuring Growth and Development

Denver Developmental Screening Test II
Screening tool birth to age 6

Screen at 3-4 months, 10 months, 3 years

Areas of development

Personal-social

Fine motor–adaptive

Language

Gross motor

CDC growth charts
Height, weight, head circumference
Plotted on standardized grid

Gender and Race

Gender
Male: larger, more muscle mass, more motor activity
Female

More physically mature at birth

Less vulnerable to stress, greater response to tactile stimulation/pain

Impact on parental relationships/expectations
Race
Physical variations among people of different races
Diversity challenges in health assessment, nursing care

Genetics

Maternal age
Down’s syndrome: >35 years old
Ethnic background
Eastern European Jews: Tay-Sachs
Blacks: sickle cell
Family history
Examples: Huntington’s chorea, hemophilia, mental retardation
Genetic counseling: informed decision re birth defects

Genetics (Cont.)

Maternal reproductive history
Spontaneous abortions, stillbirths, previous children with genetic conditions
Maternal disease
Examples: Diabetes mellitus, seizure disorder, phenylketonuria
Nurse’s role
Case finding, referral, family education during genetic counseling process

Gordon’s Functional Health Patterns

Health perception–health management pattern
Nutritional-metabolic pattern
Elimination pattern
Activity-exercise pattern
Sleep-rest pattern
Cognitive-perceptual pattern
Self-perception–self-concept pattern
Roles-relationships pattern
Sexuality-reproductive pattern
Coping–stress tolerance pattern
Values-beliefs pattern

Health Perception—Health Management Pattern

Health promotion through parents
Promote competence in parents’ ability to act to enhance infant’s health
Identify problems
Family’s perception of good/bad health practices
Consequences of unhealthy practices
Help parents recognize infant susceptibility
Teach characteristics that influence health

Nutritional-Metabolic Pattern
Essential Infant Nutrients

Water—supplied by breast milk
125-150 mL/kg/day first 6 months
125-135 mL/kg/day second 6 months
Protein: not to exceed 20%—kidney is immature
2.2 g/kg/day first 6 months
2 g/kg/day second 6 months
Fat: 3.8-6 g/kcal: breast milk is 50% fat
CHO—37% of calories in breast milk
Vitamins and minerals
Vitamin D supplementation (if breastfed)
Iron fortification by 6 months

Nutritional-Metabolic Pattern

Food additives
May be present in commercial baby food
Homemade baby food
Avoid salt/sugar/additives
Nutrition problems
Under nutrition: inadequate calories or nutrients
Overnutrition: more calories and nutrients than needed
Baby food
If home prepared must cook without salt or sugar then blenderize food—economical option
Commercial food is safe, nutritious and high quality

Nutritional-Metabolic Pattern (Cont.)

Breastfeeding: the perfect food
Exclusive: preferred method first 6 months
Continued: first year and beyond
Nurse’s role in encouraging breastfeeding
Introduction of solid foods
4-6 months: infant physiologically and developmentally ready
Recommendation: wait until 6 months to lower risk of food allergies
Sequence of solids: cereal, fruits, vegetables, meats

Nutritional-Metabolic Pattern (Cont.)

Weaning: introducing infant to cup
Gradual process: usually 5-6 months
Developmental milestones

Infant extrusion reflex needs to be absent

Infant can sit only slightly supported

Able to turn head away to indicate food refusal

Avoid propping baby bottles
Danger of aspiration
Baby bottle syndrome—tooth decay

Elimination Pattern

Bowel elimination
Develops pattern by second week of life
Breastfed stool

Softer consistency, clean smell, initially several stools daily; progresses to once daily or over several days

Bottlefed stool

Harder consistency, smellier

Similar to infant on solid food

Defecation involuntary

Delay toilet training until at least 18 months old

Urinary elimination
6-12 times/day first few months
Irregularly after first few months
Voiding involuntary

Activity-Exercise Pattern

Activity through play
Exercise of senses (visual)
Solitary and repetitious
Promoting play is important!
Activity through stimulation
Parental stimulation important to development

Singing/music, rocking

Mirrors, face-to-face interaction

“Tummy time” needed to prevent flattening of head from sleeping supine

Sleep-Rest Pattern

Sleep needs correlate to rate of growth
80% at birth
12 hours daily at 12 months
Promote infant’s sleep patterns
Sensitivity to sleep cycles, develop rituals
Not firm “schedule”
Sleep problems are highly prevalent
Bedtime rituals helpful
Brief arousals at night are normal for infants
Quiet room separate from parents is recommended

Sleep – Rest Pattern
Sudden Infant Death Syndrome

Third leading cause of death in United States/Canada
Unknown cause
Risk factors
Prone sleeping, exposure to tobacco smoke, soft sleeping surfaces, hyperthermia, bed sharing, lack of breastfeeding, SIDS sibling, preterm, near-SIDS
Recommendations
Avoid risk factors
Supine sleep position, offer pacifier
Nurse’s role in family coping/grief

Cognitive-Perceptual Pattern

Vision
Initial: eye muscles weak, vision unfocused, without meaning
Eye movements coordinate by 3 months
Eye movements mature by 6 months
Hearing
Acute ability; sound discrimination is an important developmental task
Smell
Fully developed; can differentiate odor of mother’s milk from others at 2 weeks

Cognitive-Perceptual Pattern (Cont.)

Taste
Present at birth; salivation at 3 months of age
Touch and motion
Tactile sensation well developed
Touch relieves infant tensions and speeds neuromuscular development
Language development
Sensory stimulation important
Cooing by 2 months; babbling at 6 months, single words by 12 months

Self-Perception–Self-Concept Pattern

Separating “me” from “non-me”
Developed through feedback
Effect of crying/smiling on others
Ability to use body to influence others
Messages infant receives from body
Differentiates “self” in mirror images
4 months of age
Develops body image as he or she experiences the environment through senses

Roles-Relationships Pattern

Attachment and bonding
Establishment of maternal-infant bond
Influenced by previous life experiences
Theories of attachment
Freudian psychoanalytic theory
Social learning theory
Difficulties with attachment
Increased risk: child abuse, failure-to-thrive, behavior problems
Paternal attachment/bonding: engrossment

Roles-Relationships Pattern
Child Abuse

Active or passive abuse at hands of parents or caregivers
Most common under age 3
Parenting not instinctive; response to inadequate parental coping
Women abuse more frequently
Men more severely; sexual abuse
Intergenerational cycle of behavior
Profound long-term effect on child
Community goals—ID and prevention

Roles-Relationships Pattern
Child Abuse (Cont.)

Prevention of child abuse: identification and intervention in families “at risk”
Identification of abuse when it occurs
Protection of abused/at-risk children
Scope of child abuse is extensive
650,000 infants and children annually
1,500 children die from abuse or neglect
Abuse occurs in every race, creed, or socioeconomic status

Sexuality-Reproductive Pattern

Sexual identity begins at birth
Caretaker’s behavior secondary to gender
Infant’s sexuality

Gives direction to own responses through life

Infant characteristics
Great oral sensitivity
Enjoy skin-to-skin contact
Explores own body for pleasure in infancy

Coping–Stress Tolerance Pattern

Developmental crisis
Necessary part of growth/development
Learning new skills
Situational crisis—not anticipated as part of normal growth/development
Separation from significant other

Protest: infant cries loudly; screams for mother

Despair: stops crying; withdrawn, apathetic

Withdrawal: ignores mother on her return

Infant: little initial coping ability
Gradually learned over time

Values-Beliefs Pattern

Parents’ values/beliefs influence care/development of infant
Nursing interventions
Works within parental framework
Examines own attitudes in working with families
Influencing behavior

Modeling behavior

Serving as consultant (listening)

Expressing values/attitudes;

Remaining open to other approaches

Physical Agents

Leading cause of death
Falls
Most common after 4 months (rolling over)
Do not leave unattended on raised surface
Burns
Deaths from smoke/toxic gasses
Swallowing/choking on foreign objects
Potential: any small object in mouth
Childproof environment
Infant CPR: parents and caregivers

Biological Agents
AIDS

Acquired immunodeficiency syndrome (AIDS)
Transmission: pregnancy, delivery, breastfeeding
Symptoms usually during first year: infections, developmental delays, failure to thrive
WHO and UNAIDS recommendation
Male circumcision to reduce risk of heterosexually acquired HIV infection in men
Nursing role
Education of disease process, transmission
Prevention of AIDS transmission

Biological Agents
Immunization

ICDC and AAP recommended schedule
Routine immunizations at birth; 1, 2, 4, 6 months; 12 months
Active immunization
Live, killed, or attenuated organism
Stimulates immune system to build immunity
Diphtheria; tetanus; acellular pertussis; inactivated polio; measles, mumps, and rubella
Passive immunization
Naturally occurs in newborns from maternal antibodies

Chemical Agents

Drugs
Aspirin, acetaminophen, vitamins
Childproof packaging: not absolute
Prevention

Eliminate hazards from exploring infants

Supervise infants

Poison prevention
Plants—keep out of reach
Cleaners, household supplies

Lock

Safe storage

Chemical Agents (Cont.)

Toxins: infants are vulnerable
Oral habits, unique diet
Longer life span—potential for damage
Pesticide exposure: food esp produce
Lead—disproportional exposure to infant
Breathe in more air, closer to ground
More mouth-breathing
Oral habits, greater GI absorption
Indoor air pollutants: smoke, carbon monoxide
Water pollution

Motor Vehicles

Injuries
Improper restraint
Infant on adult lap

Distracting, potential for becoming projectile

Car seats
Rear-facing safety seat for infants to 20 lb
Shield-type of “infant-only” seat to 30 lb
Heat stroke
If left unattended in motor vehicle
Dangerous temperatures occur in 15-30 minutes
Nursing implications
Teach safety; support public awareness

Radiation and Cancer

Radiation exposure
Natural background radiation (cosmic waves, soil, water, air)
Human made radiation (microwaves, electronic devices)
Infant vulnerability: rapidly growing and immature cells
Cancer
Leading cause of death from disease
Nurse’s role: risk-factor identification, screening, assessment, community education

Determinants of Health
Day Care Community and Work

Growing need for day care
Center-based facility while parents at work
Separation traumatic for both child and parent
Ideal: mother/infant together 4-6 months before being placed in day care (enhances attachment)
Nurse’s role includes:
Counseling parents on types/screening day care
Helping parents understand separation and expected behaviors
Assisting parents to deal with separation behaviors

Social Factors and Environment

Culture and ethnicity: from infant’s worldview
Power structure in the cultural group
Breastfeeding decisions
Traditional/folk beliefs
Language
Medium for understanding/working together
Strategies for removing communication barriers
Religion: impacts health
Decisions on treatment
Evaluation of health services

Levels of Policy Making and Health
Legislation

National goal: improve infant health
Strategies to decrease infant mortality
Family planning services
Pregnancy/infant services
Educational efforts on prenatal care
Immunization efforts
Nursing’s role
Participate in development of health care policy
Coordination of community resources

Economics and Nursing Role

Poverty impacts infants
Infant mortality rates higher
Higher disease rates
Delayed language development
Nursing interventions
Assess family situation, infant status
Identify community resources
Family advocate in health care system
Participate in legislative process

Health planning council, concerned citizens group

Advisory capacity to local or state legislator

Well child visits—promote and maintain health

Primary role is to provide the family with education (infancy is critical development period)
Additional roles: support and advocacy
Focusing on the nutritional needs of the infant during the first 18 months of life
Guidance to parents
Encouraging sound practices in the home to foster optimal conditions for normal growth and development

Nursing Application